Reuters (3/22) reported that the Food and Drug Administration (FDA) has “recommended updating the prescribing instructions for a Baxter International anesthesia drug,” Suprane (desflurane), “after three reports of cardiac arrest in children,” according to agency documents. The drug’s label “already carries warnings about other cardiac problems including heart attacks, irregular heart beats, and unstable blood pressure.”
NY Times, 3/24/08:
Those precautions had mixed results, and an estimated 675,000 Americans died during that outbreak, according to the Centers for Disease Control and Prevention in Atlanta.
Today, New Jersey, Connecticut and New York are much more prepared than they were 90 years ago in the event that an influenza outbreak turns into a pandemic. But five years after an avian flu outbreak in Asia made pandemic flu planning a priority, some experts are concerned that states have not been equally vigilant about preparing, and as attention and federal financing begin to decrease, they fear that preparedness efforts will slacken.
“There is a worry that there was a lot more attention to the issue two or three years ago,” said Richard Hamburg, government relations director for Trust for America’s Health, a Washington-based nonprofit health watchdog. “The fact is that it’s still spreading. There are still cases throughout the world. Preparedness is not a one-shot deal. You don’t know if this will hit this year, next year, five years, 10 years from now.”
Federal officials are tracking the flu worldwide, but it is up to cities and states to prepare their own public health plans. So in 2002, when fears of a new pandemic began to escalate, the federal government agreed to send the states billions of dollars to prepare for a pandemic. The health and human services secretary, Michael O. Leavitt, warned states in 2005 that if they expected the federal government to bail them out when a pandemic hit, they would be “tragically wrong.”
Trust for America’s Health released a report late last year examining how states were preparing for public health emergencies. The report graded the states on their efforts to protect against a pandemic. Over half of the states received a score of 5 or less for their health emergency preparedness capabilities, with 10 being the highest score.
In this region, Connecticut received a score of 8; the state lost points for failing to buy enough antivirals and failing to use a disease surveillance system that is compatible with the federal system to track the progress of an outbreak as it moves across the country. New York scored a 9 — for failing to increase public health financing as quickly as inflation, though state officials said financing has since risen — and New Jersey received a 10.
Pandemics occur when the flu virus mutates into a more deadly form and begins to spread easily from person to person. Health officials are worried about pandemic flu now because they fear the avian flu that has spread to Asia and Europe could mutate into a more deadly and transmissible form.
During the 1918 flu pandemic, which killed about 50 million worldwide, the federal government did not ask states to report their flu tallies until weeks or months after the disease had begun to spread. This time around, the government has been tracking the flu for years.
And in 1918, scientists were unable to make an effective vaccine; in an outbreak today, a vaccine could most likely be created within six months.
Connecticut, New Jersey and New York expect to use two basic methods to keep the flu under control before the vaccine is ready: antiviral drugs and a kind of mass crowd control. The federal government has bought 50 million courses of antiviral drugs that federal officials said could limit the severity of flu infections and possibly serve to protect uninfected people from the disease.
The Department of Health and Human Services has urged states to buy antivirals through a discount program that offers a federal subsidy, cutting the cost of a course of drugs (enough for one person) to $20 from $80, said Dr. William F. Raub, science adviser to Secretary Leavitt. The eventual goal is to have enough antiviral medication to cover at least one-fourth of the population.
In the region, the states have taken different approaches to stockpiling antivirals. Connecticut decided not to buy its full share of antivirals, though it has bought about 11,000 courses with federal money and sent a letter to the federal government indicating it wants to buy 8,465 more. Even after including the 520,000 courses in the federal stockpile designated for Connecticut, the state would still have only enough antivirals for about one-sixth of its population.
William Gerrish, a spokesman for the Connecticut Department of Public Health, said state officials haven’t put as much emphasis or money into antivirals as other states because they have “limited utility and limited shelf life.”
Indeed, federal officials are uncertain just how effective antivirals would be in the event of a pandemic and whether they could serve some prophylactic purpose. And because antivirals currently have a five-year shelf life, states are spending millions of dollars on medicine they may have to throw away in the next few years. But other state officials said they weren’t willing to take chances.
“If you had a novel strain causing a pandemic that was responsive to antivirals and your state had no stockpile, I could predict that the public would be pretty upset,” said Dr. Eddy Bresnitz, the state epidemiologist in New Jersey, which has bought 850,000 of the 900,000 courses available under the federal cost-sharing program. He acknowledged, however, that if the antivirals expire, “that’s a lot of dollars flushed down the drain.”
Similarly, New York has gone so far as to buy supplies of antiviral medications that were initially designated for other states that decided not to buy them.
The bulk of the planning, however, has focused on other methods to keep people from getting sick during a pandemic, ranging from surveillance to shutting down public gatherings and schools to quarantining people who are exposed to the flu and isolating those who have it.
The states have held drills for public health and safety workers to determine what to do when the flu hits, and they have developed increasingly sophisticated reporting systems that make doctors pick up the telephone immediately after seeing signs of certain diseases.
New Jersey has been particularly diligent: the state compiles analyses of school absenteeism and flu diagnoses each week and links to its pandemic flu plans from the top of its Web site. The challenge, state officials say, is keeping their plans current and local officials up to date on flu preparedness.
Meanwhile, state officials said they have received less money for outreach to local communities that they have done in the past. Congress turned down the president’s request for $870 million in this year’s budget for flu preparedness, and state officials said they expected future grants to be much more competitive.
“It means the system is a little bit thinner,” said Dr. Gus Birkhead, New York’s deputy commissioner for public health.
NBC News, 3/22/08: (3/22, story 12, 2:25, Holt) reported, “Public hospitals like San Francisco General make up two percent of America’s hospitals,” yet they “take care of 25 percent of patients with little or no medical coverage.” However, they are “disappearing at an alarming rate, down almost 22 percent since 1990.” According to Larry Gage, of the National Association of general hospitals, these closures are due to “a combination of budget cuts at almost every level of government, increased numbers of uninsured, [and] increased demand on the emergency” department “and the trauma systems.”
San Diego Union Tribune, 3/22/08: Patients with the most lethal type of heart attack are receiving lifesaving care in half the time as before 2007 under a cardiac-response system launched early last year, county officials said yesterday.
EDUARDO CONTRERAS / Union-Tribune
Dr. David Spiegel explained a procedure yesterday to patient Eleanor Kendall at Tri-City Medical Center in Oceanside. Kendall underwent angioplasty and stent placement.
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Now, paramedic ambulances carry special equipment that allows them to diagnose these heart attacks in the field. The paramedics then call any of 13 designated hospitals’ heart attack teams to let them know a patient will soon arrive so they can be prepared, said Dr. Bruce Haynes, medical director of the county’s Emergency Medical Services.In the years before the Cardiac System of Care was created, patients would arrive at the emergency room and have to wait 125 to 140 minutes before they could go into a cardiac catheterization lab and have their artery blockages cleared, Haynes said.
That time was reduced to 62 minutes during the first year of the program, which was launched in January 2007. “Medical research shows this saves lives and is truly a great benefit,” Haynes said.
He said 330 patients benefited from the new system in 2007.
Haynes, hospital cardiologists, paramedics and county officials held a news conference yesterday to announce its success. County officials said they don’t know how many deaths the program prevented or how many patients had less damage to their heart muscle because blood flow was restored faster.
But county Supervisor Greg Cox said he is sure the system has made a lifesaving impact. “Today, heart attack victims have a much better chance to survive and recover,” he said.
One of the first patients to benefit from the cardiac system was Ron Rosenbaum of San Marcos, who experienced pain in his arm a year ago and went to a Carlsbad fire station to get checked out.
The station hooked him up to an electrocardiogram machine and immediately determined he was having a type of heart attack called ST-segment elevation myocardial infarction, or STEMI. He was promptly transported to a hospital where heart specialists awaited.
“It was no time at all before I was in the cath lab . . . and had two stents put in,” Rosenbaum said. “I didn’t realize then, but I do now, how lucky I was with this system. If they didn’t have their specialized team there . . . . I might not be lucky enough to be standing here.”
One reason for delays in the old system is that paramedics would routinely take symptomatic patients to the nearest hospital, regardless of whether it had a cath lab team ready to go, seven days a week, 24 hours a day. Paramedics didn’t know which patients were having a true heart attack.
“We used to fly blind, without knowing the true condition of the patient,” said Paul Maxwell, a county paramedic.
The improvement brings the county to a speed – called a door-to-balloon time – that is even faster than the national target of 90 minutes. Hospitals across the country have been dramatically reducing their times as well. Two years ago, the national goal was 120 minutes.
Part of the success of the new system is that every ambulance with a paramedic in the county now carries a 12-lead electrocardiogram machine, county officials said. These devices can identify STEMI heart attacks.
In a STEMI, the artery is completely occluded, causing heart muscle downstream to die rapidly, said Dr. Paul Phillips, a cardiologist at Scripps Mercy Hospital in Hillcrest and one of the first to advocate the new system.
STEMIs are also called “tombstones” in part because of the heart waves’ appearance on a printout. About one in every three heart attacks is classified as a STEMI.
The blockages almost always occur in the left ventricle, and they’re far more likely to cause death more quickly than most other kinds of heart attacks.
Each year, about 400,000 people in the nation suffer a STEMI, according to the American Heart Association. Many of them die without reaching the hospital.
Non-STEMI heart attacks are less urgent because they are usually caused by clots or blockages that haven’t blocked blood flow entirely.
“You could say that other kinds of heart attacks, your kitchen sink is draining slowly, but it’s still draining. But with a STEMI, there’s no flow at all,” said Ori Ben-Yehuda, director of the Coronary Care Unit at UCSD Medical Center in Hillcrest.
The most effective way to treat a STEMI is prompt catheterization. Of the nearly 5,000 acute-care hospitals in the United States, less than half have catheterization labs and only 1,200 have equipment and specialized teams ready to do such procedures.
In San Diego County, paramedics don’t automatically route non-STEMI patients to one of the 13 hospitals participating in the cardiac-response program.
Non-STEMI heart attacks are tougher to identify. Their symptoms can resemble those of indigestion, anxiety or other problems. That’s why health experts say that people who suspect they’re having a heart attack should call 911 instead of going to the hospital themselves.
The countywide cardiac-response system was made possible in large part because of a $536,000 gift to the city of San Diego from La Jolla stock adviser Jack White, who suffered a STEMI heart attack in 2004. When paramedics arrived at his home, they couldn’t diagnose him because they lacked the 12-lead equipment, he recalled.
“They told me the city hadn’t been able to fund them to buy it, and how important it was to get this equipment because every second after a heart attack, a little more muscle is destroyed,” White said in a 2006 interview. “So I asked them how much money it would take.”
Ambulance companies, hospitals and fire departments have provided most of the remaining financial support.
Hospital officials around the county are delighted with the system.
“There’s no question that the quality of care given to people having heart attacks in this county has improved,” said Dr. Jerrold Glassman, a cardiologist and chief of staff at Scripps Mercy Hospital in Hillcrest.
Palomar Pomerado Health pioneered the STEMI-response concept in San Diego County in November 2003. Its ambulances were the first to have the 12-lead electrocardiogram machines.
Before November 2003, the average door-to-balloon time for patients using the 911 system was 136 minutes. Today, the time is 72 minutes, said Andy Hoang, a spokesman for Palomar Pomerado Health.
“That’s a huge difference,” Hoang said.
Chicago Tribune, 3/22/08: The pursuit of a synthetic version of heparin, free of animal materials and made with stricter quality controls, is gaining more attention as awareness grows that the blood thinner can be sourced from an unregulated supply chain that starts with hog lots in rural China.
The U.S. Food and Drug Administration this week disclosed that low-cost animal cartilage made its way into Baxter International Inc.’s heparin, raising fears conventional quality-control procedures do not adequately protect American consumers. Baxter’s product, recalled in the U.S. last month, has been linked to hundreds of potentially dangerous allergic reactions and at least four deaths. On Friday, the FDA said another American heparin-maker, B. Braun Medical Inc., recalled, as a precaution, more than 20 lots made by the same Chinese plant that supplied Baxter.
“The reason we are pushing for the synthetic is that you can completely control the production process,” said Jian Liu, associate professor of medicinal chemistry and natural products at the University of North Carolina School of Pharmacy, who is developing a synthetic heparin that is years from the U.S. market. “For the time being, we are stuck with the pig stuff. It has served us well for 50 years, but it was only a matter of time until something like this happened. It is too easy for the heparin extraction process to be contaminated if strict controls are not maintained.”
The synthetic process purifies the drug and its ingredients every step of the way in laboratories, in contrast to the need for scrutiny of village workshops and farms in China that are now under investigation by U.S. and Chinese health officials.
The FDA on Wednesday said as much as 50 percent of Baxter’s heparin tested from suspect lots recalled showed that the raw ingredient used to make the drug contained oversulfated chondroitin sulfate, an unapproved dietary supplement taken orally to treat joint pain.
Synthetic heparin has its own drawbacks, however. It is complex to make and development costs could push the price up between five and 40 times the $1 per-vial cost of the decades-old heparin, researchers and analysts said.
“It’s been inexpensive to derive heparin from animal sources so that there has been little incentive to consider a synthetic version of this particular heparin,” said FDA spokeswoman Karen Riley.
Indeed, Wisconsin-based Scientific Protein Laboratories four years ago opened a manufacturing plant in Changzhou, China, to keep its heparin costs low. Scientific Protein, which supplied active ingredients used to make heparin for both Baxter and B. Braun, made the move to China after supplies of pigs were inadequate in the U.S. and Canada.
Currently, there is no FDA-approved synthetically derived heparin with the broad indications awarded Baxter’s heparin, which is used for dialysis and before heart surgery. The synthetics that are available are approved for specific uses, the FDA and researchers said.
The push for synthetic heparin also comes as some industry experts wonder whether there could one day be supply issues with pigs just like there were concerns decades ago from international health officials about shortages of cow and pig pancreases that had been used for decades to make insulin.
Such concerns in the 1980s forced insulin-makers like Eli Lilly & Co. to begin to move to synthetic versions as the world’s diabetes epidemic began to take off. In 2005, the Indianapolis-based drug giant produced its last insulin derived from pigs. “If we did not think of better ways to produce it, we could be facing a potential problem because the diabetes epidemic was starting,” Lilly spokesman Scott MacGregor said.
Synthetics are being pursued in other areas. This spring, biotech company Discovery Laboratories Inc. of Warrington, Pa., expects to win FDA approval to market a synthetic lung treatment, Surfaxin, for respiratory diseases in premature babies. It hopes to compete with North Chicago-based Abbott Laboratories‘ cow-derived product known as Survanta.
Proponents of synthetics claim they’re safer. “Animal-derived products carry the risk of developing an immune response,” said Thomas Miller, senior vice president of commercial operations for Discovery.
Analysts said Surfaxin, once it’s approved by the FDA, could be $200 to $400 a vial more expensive than Abbott’s product, and Discovery will have to convince insurance companies the expense is worth it. But Miller believes doctors and hospitals will find it as a long-overdue alternative.
“If it was my child, this would be my choice,” Miller said. “I don’t think cost would be at the top of my mind in my decision analysis.”
Abbott, however, said “there is no evidence that synthetic sources are inherently safer or more efficacious than naturally derived ones.”
AP, 3/11/08: Two sets of parents in Belgium were recently sentenced to five months in prison for failing to vaccinate their children against polio. Each was also fined $8,000. The polio vaccine is the only vaccination required by Belgian law, unlike the United States, where immunizations against many other diseases are required. And unlike the United States, where many state laws allow children to opt out if their parents have religious or philosophical objections, Belgium allows exemptions only if parents prove their child might have a bad reaction to the vaccine. Reaction from some ethicists and public health experts backs the hard-line stance. “At the end of the day, the law must be respected,” said Dr. Victor Lusayu, head of Belgium’s international vaccine center. John Harris, a professor of bioethics at the University of Manchester, had a similar view: “Nobody has the right to unfettered liberty, and people do not have a right to endanger their kids. The parents in this case do not have any rights they can appeal to. They have obligations they are not fulfilling.” Polio is highly infectious, and despite a 99 percent drop in cases since a World Health Organization (WHO) eradication effort began in 1988, the virus is still endemic in Afghanistan, India, Nigeria, and Pakistan. “It is up to individual countries to decide their own policies, but we do not feel that imprisonment would help,” said Dr. David Heymann, WHO’s top polio official.
Postings # 704, 707, 711, 714, 715.
This abstract from a recent J. Emerg Med cautions us to think about acute diverticulitis when faced with a person under 40 years of age with atypical belly pain. The incidence of such a disease entity is growing in the younger population. The ones at most risk are males and those who have a pants size as large as Madagascar. 25% may have their pain localized to the RLQ. CT should make the diagnosis for you.
http://omniphysicians.com/2008/03/23/diverticulitis-in-the-young/
This article is for Dr. L., a cheese gourmand par excellance! Reports indicate that some of the mozzarella in the Naples is contaminated with dioxin. The toxicity first came to light when Italians suddenly began talking like Marlon Brando in The Godfather.
http://omniphysicians.com/2008/03/23/malignant-mozzarella/
The FDA is cautioning the public about not buying cantaloupes coming from Honduras (Really! No joke). Seems that a batch contained salmonella and some Americans and Canadians have taken ill. The salmonella actually have been arrested as illegal aliens (That’s a joke!).
http://omniphysicians.com/2008/03/23/cantaloupes-come-out-with-your-hands-up/
PRES refers to Posterior Reversible Encephalopathy Syndrome. It’s rare, it’s reversible if caught and treated early, and it’s most common in pre-eclamptic and eclamptic women. This abstract from J Emerg Med will give you an idea about it.
http://omniphysicians.com/2008/03/23/pres/
Today’s NY Times reports that the life-expectancy gap is widening between the “haves” and “have-nots.” It’s not true that The Times also reported that based on these findings, Dr Mohler should live to 126!
http://omniphysicians.com/2008/03/23/me-rich-me-live-long-me-poor-me-die-quick/
Reversible posterior leukoencephalopathy syndrome is a clinicoradiologic entity characterized by headaches, altered mental status, seizures, and visual loss and is associated with white matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain.[1] There has been some controversy about what the proper term should be for this entity because MRI has shown that lesions can occur in both gray and white matter. Therefore, a new name, posterior reversible encephalopathy syndrome (PRES), has been coined.[2] Most cases of PRES occur with hypertension or immunosuppression, but it can occur with many diverse clinical entities.[1,3] Since PRES is often unsuspected by clinicians, recognition of the characteristic imaging findings by radiologists is key to diagnosing this syndrome and should prevent deleterious work-ups or therapies.
The pathophysiology of PRES is under debate, but it is related to disordered cerebral autoregulation. Two pathophysiologic mechanisms have been proposed regarding cerebral autoregulation—cerebral vasospasm, which results in cytotoxic edema,[4] and vasodilatation, which results in vasogenic edema.[5] The latter is more favored by most experimental and clinical data.[6,7] The pathophysiology of PRES also implicates endothelial dysfunction, especially in cases without severe hypertension, such as pre-eclampsia or cytotoxic therapies.[1]
The most characteristic imaging pattern in PRES is the presence of edema involving the white matter of the posterior portions of both cerebral hemispheres, especially the parieto-occipital regions, in a relatively symmetric pattern that spares the calcarine and paramedian parts of the occipital lobes.[1] However, other structures (such as the brain stem, cerebellum, and frontal and temporal lobes) may also be involved, and although the abnormality primarily affects the subcortical white matter, the cortex and the basal ganglia may also be involved.[8] Although they are rare, gyriform signal enhancement or parenchymal hemorrhage can occur in complicated cases.[9] Recently, studies with diffusion-weighted sequences[6] and diffusion-tensor sequences[7] have shown increased apparent diffusion coefficients (ADCs) in the involved regions accompanied by anisotropy loss, which suggests reversible vasogenic edema as an underlying pathophysiology. Therefore, early diagnosis and treatment is essential for the patients’ prognosis.
Posterior reversible leukoencephalopathy syndrome is a clinicoradiologic entity associated with hypertension, immunosuppression, or many diverse clinical entities. Since PRES is often unsuspected by clinicians, recognition of the characteristic imaging findings by radiologists is key to diagnosing this syndrome and should prevent deleterious work-ups or therapies.
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Intro: Posterior reversible encephalopathy syndrome (PRES) refers to a clinicoradiological entity characterized by headache, confusion, visual disturbances, seizures and posterior transient changes on neuroimaging. Here is an abstract of a case report involving an eclamptic patient with PRES.
Journal of Emergency Medicine
Volume 33, Issue 4, November 2007, Pages 377-379
Posterior Reversible Encephalopathy Syndrome (PRES) in a Thirty-Six-Week Gestation Eclamptic
Emilie S. Powell MD, MBA and Mitchell J. Goldman DO
Posterior reversible encephalopathy syndrome (PRES) is a transient clinical neuroradiological entity characterized by clinical signs and symptoms including hypertension, generalized seizure activity, altered mental status, headache, and vision changes; along with characteristic findings on head computed tomography or magnetic resonance imaging scan. Albeit a rare condition, PRES is most commonly reported in the literature in association with obstetric patients suffering from pre-eclampsia or eclampsia. In the acute setting, it is important to recognize the characteristics of PRES and immediately treat the inciting conditions: the patient’s hypertension and seizures. Although this condition is usually transient and completely reversible, ischemic injury and irreversible damage have been reported. In the event of early and effective treatment, cognitive function may be completely restored. The following case report reviews a pregnant patient who presented to the Emergency Department with generalized seizure activity and a clinical picture characteristic of PRES. The case demonstrates how appropriate treatment in the acute setting allows complete restoration of cognitive function in the long term.
Journal of Emergency Medicine
Volume 33, Issue 4, November 2007, Pages 363-366
Christopher D. Cole MD and Allan B. Wolfson MD
Diverticulitis has long been regarded as a disease of the elderly, but its incidence has been increasing in those under age 40. Younger patients with diverticulitis are more likely to be male and obese. They often have atypical presentations, and 25% may have right lower quadrant pain. Not surprisingly, the condition is often misdiagnosed, resulting in unnecessary surgery. An abdominal CT scan is the modality of choice for diagnosis, but the most important diagnostic step is simply to include diverticulitis on the differential diagnosis of a young person with lower abdominal pain.
From the 3/11/08 San Francisco Chronicle: Legislation to create uniform standards for homeless shelters is expected to be enacted soon by San Francisco’s board of supervisors and mayor. “I think we will definitely see a healthier and more positive environment for people who have to use the shelters,” said City Supervisor Tom Ammiano, who introduced the legislation after years of complaints about the shelters’ sanitary conditions. Under the pending law, shelters must provide soap, toilet paper, clean drinking water, and bath towels to people who stay there, as well as telephone access and a secure place to store belongings and medicine. Staff at the shelters would be required to undergo training on how to interact positively with people who have mental illness or abuse drugs and alcohol, and how to interact with gay, lesbian, bisexual or transgender populations and people with disabilities. “This makes it very clear to anyone contracting with the city that these are the rules and these are the standards,” said Dariush Kayhan, the Mayor’s homeless-policy director. “Our goal right now is to decrease street homelessness,” Kayhan said, adding that the legislation is intended to change the idea among the homeless that shelters are a refuge of last resort. The city has also agreed to cover the additional expenses, which total about $135,000 per year and a one-time expenditure of $108,000 for laundry machines. The Board of Supervisors is expected to approve the legislation this week.
CNN, 3/22/08: Makers of Italy’s prized buffalo mozzarella took out full-page ads in Italian newspapers Friday assuring consumers the cheese was safe after high levels of dioxin were found in some samples of buffalo milk.
The tainted products came from a few buffalo dairies in the southern Campania region, whose reputation as a top agricultural producer already has been tarnished by the months-old garbage crisis that has fueled fears of food contamination.
Dioxin, a chemical environmental pollutant, can be hazardous even in small amounts. When it accumulates in the body, it can be linked to cancer, birth defects and organ failure.
Over the past week, Italian authorities have searched dozens of buffalo dairies and seized milk samples for tests after higher-than-permitted levels of dioxin were discovered in products from 29 mozzarella makers, news reports said.
Prosecutors in Naples have placed 109 people under investigation in connection with the probe, on suspicion of fraud and food poisoning, the ANSA news agency reported.
On Friday, the consortium of buffalo mozzarella makers in Campania took out full-page ads in Corriere della Sera and other national newspapers outlining the system of controls that are in place for its top-branded mozzarella, which carries the designation DOP, meaning it has certain protection and quality guarantees.
Health officials, police, agricultural and cheese authorities all guarantee the safe production of DOP mozzarella, the ad said, adding that the dairies involved in the police seizures were not members of the consortium.
“Considering these norms, buffalo milk — before being transformed — is placed under the most stringent health and chemical controls which guarantee the safety and quality of Campania’s DOP buffalo mozzarella,” the ad said.
The Italian agricultural lobby Coldiretti called for a speedy investigation to determine which dairies were to blame, since buffalo mozzarella is such an important brand domestically and internationally.
The soft and subtly flavored mozzarella is a key ingredient in pizza, but also is eaten uncooked, often alongside prosciutto or with sliced tomatoes and basil.
Coldiretti said 33,000 tons, worth €300 million ($462.69 million), of DOP mozzarella is produced annually, employing some 20,000 people. Most DOP mozzarella is consumed in Italy, but 16 percent is exported, mostly to European countries but also to Japan and Russia, Coldiretti said.
It was not clear what, if any, role Campania’s garbage crisis has had on the mozzarella contamination. However, earlier this year Naples health authorities began screening residents for dioxin contamination amid accusations that toxic garbage was being dumped illegally by the mafia-controlled garbage industry in the area.
Naples and its surrounding area have been plagued by garbage crises over the past dozen years. Dumps close after filling up, and residents — afraid that toxic garbage is being dumped — block efforts to open new ones.
A recent study by the World Health Organization found that people living in Campania were not as healthy as residents in the rest of Italy. Mortality rates, particularly from some forms of cancer, are higher in the areas around Naples where the garbage crisis peaked.
Still, Renato Pizzuti, a regional epidemiologist, said a direct link to garbage contamination cannot be made.
“For sure, the population of the Campania region is suffering from some negative health factors, both in terms of mortality, above all, and for some pathologies in terms of morbidity.” But in a recent interview with AP Television News, he stressed, “This cannot be directly linked to garbage.”
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NY Times, 3/23/08: New government research has found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades.
Life expectancy for the nation as a whole has increased, the researchers said, but affluent people have experienced greater gains, and this, in turn, has caused a widening gap.
One of the researchers, Gopal K. Singh, a demographer at the Department of Health and Human Services, said “the growing inequalities in life expectancy” mirrored trends in infant mortality and in death from heart disease and certain cancers.
The gaps have been increasing despite efforts by the federal government to reduce them. One of the top goals of “Healthy People 2010,” an official statement of national health objectives issued in 2000, is to “eliminate health disparities among different segments of the population,” including higher- and lower-income groups and people of different racial and ethnic background.
Dr. Singh said last week that federal officials had found “widening socioeconomic inequalities in life expectancy” at birth and at every age level.
He and another researcher, Mohammad Siahpush, a professor at the University of Nebraska Medical Center in Omaha, developed an index to measure social and economic conditions in every county, using census data on education, income, poverty, housing and other factors. Counties were then classified into 10 groups of equal population size.
In 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.
After 20 years, the lowest socioeconomic group lagged further behind the most affluent, Dr. Singh said, noting that “life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”
“If you look at the extremes in 2000,” Dr. Singh said, “men in the most deprived counties had 10 years’ shorter life expectancy than women in the most affluent counties (71.5 years versus 81.3 years).” The difference between poor black men and affluent white women was more than 14 years (66.9 years vs. 81.1 years).
The Democratic candidates for president, Senators Hillary Rodham Clinton of New York and Barack Obama of Illinois, have championed legislation to reduce such disparities, as have some Republicans, like Senator Thad Cochran of Mississippi.
Peter R. Orszag, director of the Congressional Budget Office, said: “We have heard a lot about growing income inequality. There has been much less attention paid to growing inequality in life expectancy, which is really quite dramatic.”
Life expectancy is the average number of years of life remaining for people who have attained a given age.
While researchers do not agree on an explanation for the widening gap, they have suggested many reasons, including these:
¶Doctors can detect and treat many forms of cancer and heart disease because of advances in medical science and technology. People who are affluent and better educated are more likely to take advantage of these discoveries.
¶Smoking has declined more rapidly among people with greater education and income.
¶Lower-income people are more likely to live in unsafe neighborhoods, to engage in risky or unhealthy behavior and to eat unhealthy food.
¶Lower-income people are less likely to have health insurance, so they are less likely to receive checkups, screenings, diagnostic tests, prescription drugs and other types of care.
Even among people who have insurance, many studies have documented racial disparities.
In a recent report, the Department of Veterans Affairs found that black patients “tend to receive less aggressive medical care than whites” at its hospitals and clinics, in part because doctors provide them with less information and see them as “less appropriate candidates” for some types of surgery.
Some health economists contend that the disparities between rich and poor inevitably widen as doctors make gains in treating the major causes of death.
Nancy Krieger, a professor at the Harvard School of Public Health, rejected that idea. Professor Krieger investigated changes in the rate of premature mortality (dying before the age of 65) and infant death from 1960 to 2002. She found that inequities shrank from 1966 to 1980, but then widened.
“The recent trend of growing disparities in health status is not inevitable,” she said. “From 1966 to 1980, socioeconomic disparities declined in tandem with a decline in mortality rates.”
The creation of Medicaid and Medicare, community health centers, the “war on poverty” and the Civil Rights Act of 1964 all probably contributed to the earlier narrowing of health disparities, Professor Krieger said.
Robert E. Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation, said one reason for the growing disparities might be “a very significant gap in health literacy” — what people know about diet, exercise and healthy lifestyles. Middle-class and upper-income people have greater access to the huge amounts of health information on the Internet, Mr. Moffit said.
Thomas P. Miller, a health economist at the American Enterprise Institute, agreed.
“People with more education tend to have a longer time horizon,” Mr. Miller said. “They are more likely to look at the long-term consequences of their health behavior. They are more assertive in seeking out treatments and more likely to adhere to treatment advice from physicians.”
A recent study by Ellen R. Meara, a health economist at Harvard Medical School, found that in the 1980s and 1990s, “virtually all gains in life expectancy occurred among highly educated groups.”
Trends in smoking explain a large part of the widening gap, she said in an article this month in the journal Health Affairs.
Under federal law, officials must publish an annual report tracking health disparities. In the fifth annual report, issued this month, the Bush administration said, “Over all, disparities in quality and access for minority groups and poor populations have not been reduced” since the first report, in 2003.
The rate of new AIDS cases is still 10 times as high among blacks as among whites, it said, and the proportion of black children hospitalized for asthma is almost four times the rate for white children.
The Centers for Disease Control and Prevention reported last month that heart attack survivors with higher levels of education and income were much more likely to receive cardiac rehabilitation care, which lowers the risk of future heart problems. Likewise, it said, the odds of receiving tests for colon cancer increase with a person’s education and income.
Chicago Tribune, 3/23/08: J.J. Jamison, a “borderline” diabetic who closely monitors his blood sugar, has been missing his sweets. So after reading about stevia and alternative sweeteners in a recent Q cover story, the 61-year-old DeKalb resident e-mailed asking, “What about agave?”
Agave’s naturally sweet sap, once strictly a famous source of tequila, is growing more popular among diabetics and others seeking natural sugar substitutes. The amber-colored nectar contains about 90 percent fructose, a natural sugar found in plants.
But agave, commercially produced as a sweetener in Mexico since the 1990s, is still something of a wild card. Registered dietitian Dave Grotto touts its low glycemic index and lists agave in his book “101 Foods That Could Save Your Life!” Others charge that agave is toxic, harmful to pregnant or lactating women and intentionally mislabeled.
“Agave is really chemically refined hydrolyzed high-fructose inulin syrup and not from the blue agave plant, organic or raw as claimed,” said Russ Bianchi, a food and beverage formulator.
The Food and Drug Administration says there is no evidence of safety concerns. But in the past, agave products may have been “economically adulterated or misbranded by adding corn syrup or high-fructose corn syrup [HFCS],” said FDA spokesman Michael Herndon. Chronic shortages of the plant make this a real concern, especially for products purchased over the Internet. But Whole Foods and Trader Joe’s carry agave nectar or syrup. And Madhava agave nectar is a popular option at the Wild Tree Cafe in Evanston, where owner Jaqi Boyer uses it in soups and baked goods for both diabetic and vegan customers.
Grotto likes agave because “it doesn’t impact blood glucose [glycemic] levels as dramatically as other sweeteners such as cane sugar,” he said. “And because it is sweeter than table sugar, you don’t need to use as much.”
Agave also contains a complex form of fructose called inulin, Grotto said. “Bifodobacteria, a type of friendly bacteria, digests inulin to produce short-chain fatty acids that have been shown to fight colon cancer,” he wrote. Agave’s sapogenins, meanwhile, have anti-inflammatory and anti-cancer properties, Grotto said. But others dismiss agave as “expensive fructose.”
“It’s almost all fructose, highly processed sugar with great marketing,” said Dr. Ingrid Kohlstadt, a fellow of the American College of Nutrition and an associate faculty member at Johns Hopkins School of Public Health. “Fructose has a low glycemic index so it doesn’t raise blood glucose.” But it raises blood fructose, which is worse.
“Fructose interferes with healthy metabolism when taken at higher doses,” she said. “Many people have fructose intolerance like lactose intolerance. They get acne or worse diabetes symptoms even though blood glucose is OK.”
Grotto disagreed, adding that there is no scientific evidence showing an association between sugar and acne. His bottom line is that “excess consumption of any sweetener is not wise. But honey and agave syrup are value-added sweeteners, if used moderately.”
If you use agave:
• Botulism spores can be found in bottled sweeteners originally derived from natural products. Treat it like honey; don’t give it to children under age 1.
• Avoid it if you’re pregnant; some believe it can cause miscarriages.
• Seek out an agave product that is organic and carries the official USDA seal.
• The FDA says there is no current need for regulatory action but would like to know if there is any literature or other information that shows agave causes adverse effects, Herndon said.
MarketWatch, 3/23/08: The Food and Drug Administration warned that cantaloupes from a Honduran producer may be tainted with salmonella and it detained all shipments of cantaloupes by the company.
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